| Tai
Chi & Qigong Fall 2010 Class and Workshop Registration |
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| Name | |||||
| Address | |||||
| City, State Zip | |||||
| Phone | Print Clearly Email | ||||
| Emergency Contact Name & Number | |||||
| Please
indicate the classes / workshops you are interested in attending: |
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| Please
indicate your health concerns: |
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| What
would you like to gain from your classes and workshops? |
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| Session
/ Workshop and dates attending: |
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Fall session runs 14 weeks; for mid-term enrollment, contact Kim for pro-rated fee.
Those under 18 or over 70 take 20% off session prices; over 80, take 50% off. New students may join any time at a pro-rated session fee.
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| How did you hear about Embrace the Moon? | |||||
| Would
you like to be added to our confidential email notice for future workshops
and classes? We never sell or share our list. ___ yes ___ no |
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